By signing this form, you are agreeing to the following: "I declare, under penalty
of perjury, (1) that this application has been examined by me, (2)
the statements are made in good faith pursuant to the City of Arvada
tax laws and regulations and to the best of my knowledge and belief,
are true, correct and complete, and (3) I am lawfully present in U.S.
and will provide evidence of lawful presence if requested."

Signature

Authorized Signature *To sign this form, please type your first and last name in the box above.